CGSS Ambassador, Center for Global & Strategic Studies (CGSS), Islamabad
The outbreak of the Novel Coronavirus (COVID-19) in December 2019 started in China and it was declared a pandemic in March 2020, by World Health Organization. It has affected more than 200 countries around the world with total number of COVID-19 patients being more than two million and number of deaths reported to be 177,338 as of 22nd April, 2020. Pakistan has also been affected by the pandemic with more than 14,788 patients and 322 deaths till April 28, 2020. Although the number of children affected by the disease is small, and most of the affected children show only mild symptoms, the disease and the containment measures are likely to negatively impact the mental health & well-being of children. Even though children all over the world are going to be affected, those with disabilities, living in slums, isolation centers, and conflicts zones are going at a greater risk. This article provides an insight into the mental health challenges faced by children and adolescents in the wake of recent COVID-19 pandemic.
Significance of child and adolescent
mental health in relation to pandemics
Public health emergencies like pandemics, take a toll on physical as well as mental health. Children are particularly vulnerable because of their limited understanding of the event. They are unable to escape the harms of the situation physically and mentally as they have limited coping strategies. They may not be able to communicate their feelings like the adults. Closure of schools and separation from friends can cause stress and anxiety in children. Exposure to mass media coverage of crisis event and unverified information circulating on social media may aggravate the mental distress. Response of a child to a crisis situation depends upon his prior exposure to emergency situations, his physical and mental health, socio-economic circumstances of the family, and cultural background. Different studies have shown that crisis events negatively impact the psychological wellbeing of children. Anxiety, depression, disturbances in sleep and appetite as well as impairment in social interactions are the most common presentations. A recent study conducted in Pakistan screened children and adolescents for behavioral and emotional distress due to the Covid-19 pandemic. Clinginess, distraction, irritability, and fear that family members can contract the deadly disease were the most common behavioral problems identified.
Impact of current disease containment
measures on child mental health
Pakistan, like many other countries, has asked its citizens to practice social distancing in order to combat the spread of Covid-19. Educational institutions have been closed, exams have been postponed, shopping malls, restaurants, and all areas of public gathering are under a strict lockdown. The rapid rise in the number of infected cases and deaths, disruption of daily routines, home confinement, fear of infection, social distancing from peers and friends, and lack of access to educational resources have created a feeling of uncertainty and anxiety among the children and the adolescents. Disease containment measures though necessary, can adversely affect child & families’ well-being due to various reasons.
Increased Screen time
In these testing times of social isolation, children and teens are becoming exposed to the excessive media coverage of the pandemic. On one hand, electronic and social media is providing continuous updates on nationwide situation, and advising people to adopt social distancing but on the other hand, it is also creating sensationalism. The screen time of children and adolescents has increased manifold as they are confined to their homes. Excessive television exposure led to increased incidences of Post-Traumatic Stress Disorder (PTSD) and other mental health disorders. There are fears that similar disorders can develop in children due to excessive usage of electronic and social media. Furthermore, excessive social media usage makes children vulnerable to online predators, cyberbullying and potentially harmful content.
Many families are isolated at home, under great stress, and unable to receive in-person support. Confinement, social isolation, and inability to use familiar coping mechanisms like taking personal space, visiting with family/ friends, or going to mall or movie theatre, dining out or going for a long drive on car or motorcycle with spouse or friend may exacerbate the impact of these stressors. Stable, supportive, and nurturing caregiver relationship offer young children fostering trust, positive social-emotional development, and the capacity to form a secure and strong relationship in the future. A disaster such as the COVID-19 pandemic may cause parents and caregivers to become fearful and worried about their own concerns about health and the inability to meet demanding economic needs especially in developing countries like Pakistan. Extensive research shows that fear can be contagious and children are extremely sensitive to the emotional state of the adults around them, who are their essential source of security and emotional wellbeing. The pandemic has disrupted the financial and economic activities around the world creating a sense of uncertainty among the masses.
Older children and adolescent may feel disappointed for missing birthday parties, school plays, dance competitions, hanging out with their friends, sport activities like playing cricket in playground with other team members, as well as not being able to visit their grandparents, aunts, friends, and cousins. As articulated by psychologist Erik Erikson, Identity vs Role Confusion is the fifth of eight stages of psychosocial development that takes place between the ages of twelve and nineteen. Important event during this stage is social relationship. Teenagers and college students have amplified energy, novelty, motivation, curiosity, and enthusiasm that make them hard to isolate at home. The hormonal changes that come with puberty collude with adolescent social dynamics to make them highly attuned to social status, peer group, and relationships. Teens may feel frustrated, nervous, disconnected, nostalgic, and bored because of social distancing during this pandemic. Children with special needs: Children with special needs are particularly vulnerable to the negative psychological impacts of disasters.14 School closures can have significant impact on the lives of those with special needs. Children with autism spectrum disorder and neurocognitive disability can become frustrated due to disruptions in their daily routines. Their regular therapy sessions may get interrupted and they are more likely to show problematic behaviors such as irritability, aggression and social withdrawal.
Children in Quarantine
Children quarantined under the suspicion of having covid-19 or diagnosed with the disease are likely to develop mental health disorders such as anxiety, acute stress, and adjustment disorders. Separation from parents, stigmatization, fear of an unknown disease, and social isolation can all have a negative psychological impact on children.
Interventions for promoting
child mental health during
COVID-19 General Interventions:
Although all the world health agencies and governments are working tirelessly to contain the deadly virus, much more needs to be done to combat the mental and psychological impact of the disease. Nevertheless, several world health agencies including WHO, UNICEF, AACAP, IACAPAP, and many others have issued guidelines and factsheets to help parents safeguard the mental health of their children in these testing times. These guidelines are based on the basic principles of reassuring the children, educating them about the situation in age appropriate ways, and maintaining daily routines. Other guidelines include educating children on maintaining safe distances and practicing personal hygiene, acknowledging their distress and answering all their questions with honesty. Parents should avoid unnecessary separation from children and if separated from parents, children should have alternate care givers available, and they should be able to contact parents regularly. Exposure of children to panic provoking news on media should be avoided and positive use of social media should be encouraged e.g. to form support groups etc. Furthermore, screen time of children should also be monitored.
Set times for a few regular activities each day such as home tutoring, telephone calls with a friend, or cooking together, family meals; do these activities at the same time each day.
• Make sure they spend some time outdoors every day, or do some exercise daily. If one can’t go outside, try to spend at least two hours by a window, looking into the daylight, and focusing on being calm.
• Social interactions are important, even during social distancing; videoconferencing, telephone, or real-time text-messaging may be worth to consider, possibly at the same time each day.
• Avoid frequent day time naps, especially later in the day; if they must nap, restrict the nap to 30 minutes—napping can make it hard to go to sleep at night.
• Avoid bright (especially blue) light like computer screens, smartphones in the evening. Blue spectrum light suppresses the hormone that helps us sleep.
• Advise adolescents to stick to a consistent sleep and wake time that fits their natural rhythms.
• If child is sad about not having a birthday party, or missing an important social event, validate his/her feeling of sadness and frustration, acknowledge their losses, listen empathically to their thoughts, feeling and emotions, and collaboratively explore some possible solutions. Arranging a surprise birthday party with family and friends on Zoom might not sound too crazy!
Ignoring the immediate and long-term psychological effects of COVID-19 Pandemic would be disastrous, especially for children and young people, who account for almost 50% of population in Pakistan. Interventions need to focus on nurturing resilience in children and adolescents by better communication to address their fears and concerns, encouraging routines and physical activities, and taking measures to alleviate loneliness. Parents need to look after their own mental health, coping strategies, and model positive psychological attitude in order to support children and adolescents to get through this difficult time.